Maternal-Fetal Medicine Practice Questions

Q: Which of the following is NOT a criterion for expectant management in pre-eclampsia?

Blood pressure > 140/90 mm Hg. In pre-eclampsia, the decision between expectant management and delivery depends on the severity of the disease and the presence of **"Features of Severity."** **Explanation of the Correct Answer:** **Option B (BP > 140/90 mm Hg)** is the correct answer because it is the **baseline definition** of pre-eclampsia, not a contraindication to expectant management. Expectant management is typically considered in stable patients with "Pre-eclampsia without severe features" between 24 to 34 weeks of gestation. A blood pressure of 140/90 mm Hg is mild; only when BP reaches **≥ 160/110 mm Hg** (Severe Hypertension) does it become a criterion to reconsider expectant management or initiate urgent antihypertensive therapy. **Analysis of Incorrect Options (Criteria for Termination/Severe Features):** Expectant management is contraindicated (or must be terminated) if any of the following severe features develop, as they indicate end-organ damage: * **Option A (Platelets < 100,000/ml):** Indicates thrombocytopenia, a sign of HELLP syndrome or worsening coagulopathy. * **Option C (Urine output < 400 ml/day):** Indicates oliguria and impending renal failure. * **Option D (Persistent headache):** Represents cerebral symptoms (neurological involvement) and is a precursor to eclampsia (seizures). **High-Yield NEET-PG Pearls:** * **Definitive Treatment:** The only definitive cure for pre-eclampsia is the delivery of the placenta. * **Expectant Management Goal:** To improve fetal maturity (administer steroids) without compromising maternal safety. * **Absolute Indications for Delivery:** Eclampsia, Abruptio Placentae, Pulmonary edema, DIC, and Non-reassuring fetal heart rate. * **Magnesium Sulfate ($MgSO_4$):** The drug of choice for seizure prophylaxis in severe pre-eclampsia.

Q: Metcalfe's Criteria is used for:

Findings suggestive of heart disease in pregnancy. ### Explanation **Correct Answer: C. Findings suggestive of heart disease in pregnancy** **Understanding Metcalfe’s Criteria** During a normal pregnancy, physiological changes—such as increased cardiac output, tachycardia, and peripheral edema—often mimic symptoms of organic heart disease. To differentiate between normal physiological adaptations and true pathology, **Metcalfe’s Criteria** (also known as Burwell and Metcalfe’s Criteria) are used. According to these criteria, heart disease is suspected if any of the following are present: 1. **Diastolic murmur** (always pathological). 2. **Systolic murmur** of Grade III intensity or higher. 3. **Unequivocal cardiomegaly** on imaging. 4. **Severe arrhythmia** (e.g., atrial fibrillation or flutter). **Analysis of Incorrect Options:** * **Option A:** Maternal mortality risk is typically assessed using the **Modified WHO (mWHO) Classification**, which categorizes cardiac conditions based on the risk of pregnancy-related death. * **Option B:** Grading of valvular diseases is done via echocardiographic parameters (e.g., valve area, pressure gradients) and is not specific to Metcalfe’s criteria. * **Option D:** Cardiomyopathies are classified based on morphology and physiology (e.g., Dilated, Hypertrophic, Restrictive) or timing (e.g., Peripartum Cardiomyopathy). **High-Yield Clinical Pearls for NEET-PG:** * **Most common heart disease in pregnancy (India):** Rheumatic Heart Disease (Mitral Stenosis is the most common lesion). * **Most common heart disease in pregnancy (Developed nations):** Congenital Heart Disease. * **NYHA Classification:** Used to assess the *functional capacity* and severity of symptoms in pregnant patients with known heart disease. * **Danger periods:** The risk of heart failure is highest at **28–32 weeks** (peak blood volume), during **labor**, and immediately **postpartum** (autotransfusion from the uterus).

Q: Which of the following does NOT constitute a high-risk pregnancy?

A 25-year-old primigravida. **Explanation:** A **high-risk pregnancy** is defined as one in which the mother, the fetus, or the newborn is at an increased risk of morbidity or mortality due to conditions preceding or accompanying the pregnancy. **Why Option B is Correct:** A **25-year-old primigravida** represents the ideal biological age for childbearing. In obstetrics, the "safe" age for pregnancy is generally considered between 20 and 30 years. Since there are no associated medical or obstetric complications mentioned, this is considered a **low-risk or "normal" pregnancy.** **Why the other options are High-Risk:** * **Twins (Multiple Pregnancy):** This is high-risk due to increased chances of preterm labor, pre-eclampsia, gestational diabetes, and postpartum hemorrhage (PPH). * **Hydramnios (Polyhydramnios):** Excessive amniotic fluid is associated with maternal diabetes, fetal anomalies (e.g., esophageal atresia), cord prolapse, and placental abruption. * **Previous LSCS:** This constitutes a high-risk case due to the risk of **scar dehiscence or rupture** in subsequent pregnancies, as well as an increased incidence of morbidly adherent placenta (Placenta Accreta Spectrum). **Clinical Pearls for NEET-PG:** * **Elderly Primigravida:** A woman becoming pregnant for the first time at age **≥35 years** is considered high-risk. * **Teenage Pregnancy:** Pregnancy at age **<18-19 years** is high-risk due to increased risks of cephalopelvic disproportion (CPD) and pre-eclampsia. * **Stature:** A maternal height of **<140-145 cm** (short stature) is a high-risk factor for CPD. * **Grand Multipara:** A woman who has had **4 or more** previous viable births is at high risk for malpresentations and atonic PPH.

Q: A 24-week pregnancy scan revealed frontal facial fetal defects suggestive of Moebius syndrome. Which of the following could account for the teratogenic effects?

Misoprostol. **Explanation:** **Misoprostol** is a synthetic prostaglandin E1 (PGE1) analogue. When used in the first trimester for failed medical abortion, it can cause uterine contractions leading to **vascular disruption** in the developing fetus. This vascular insult (specifically involving the subclavian artery or cranial vessels) results in **Moebius Syndrome**, characterized by congenital paralysis of the 6th (abducens) and 7th (facial) cranial nerves, often associated with limb reduction defects and orofacial malformations. **Analysis of Incorrect Options:** * **Mifepristone (A):** An anti-progestogen used for medical abortion. While it terminates pregnancy by blocking progesterone receptors, it is not specifically linked to the vascular disruption sequence seen in Moebius syndrome. * **Dinoprostone (C):** A PGE2 analogue used primarily for cervical ripening and induction of labor at term. It is not typically associated with first-trimester teratogenicity leading to Moebius syndrome. * **Methotrexate (D):** A folate antagonist. Teratogenicity (Fetal Methotrexate Syndrome) typically presents with "cloverleaf skull," craniosynostosis, wide-set eyes, and limb defects, rather than the specific cranial nerve palsies of Moebius syndrome. **NEET-PG High-Yield Pearls:** * **Moebius Syndrome Triad:** Facial paralysis (mask-like facies), impaired lateral eye movement, and limb deformities (e.g., clubfoot). * **Vascular Disruption Sequence:** The same mechanism (Misoprostol) can also cause **Poland Syndrome** (unilateral absence of pectoralis major and syndactyly). * **Safe Use:** Misoprostol is highly effective for PPH prophylaxis and medical abortion, but patients must be counseled on the teratogenic risks if the pregnancy continues.

Q: What are the causes of hydramnios?

All of the above. **Explanation:** Hydramnios (Polyhydramnios) is defined as an amniotic fluid index (AFI) > 25 cm or a single deepest pocket (SDP) > 8 cm. It occurs when there is either an **overproduction of fetal urine** or an **impairment in fetal swallowing/absorption** of amniotic fluid. **Why "All of the Above" is Correct:** * **Anencephaly (A):** This is a classic cause of polyhydramnios due to two mechanisms: 1. **Failure of swallowing reflex** because of the absence of the forebrain and neural centers. 2. **Transudation of fluid** from the exposed meninges/exposed plexus. 3. **Lack of Antidiuretic Hormone (ADH)** leading to excessive fetal polyuria. * **Oesophageal Atresia (B):** This represents a mechanical obstruction. Since the fetus cannot swallow the amniotic fluid, it cannot be absorbed by the fetal gastrointestinal tract, leading to fluid accumulation in the amniotic sac. * **Twins (C):** Polyhydramnios is common in multiple gestations, particularly in **Monochorionic Diamniotic (MCDA) twins** as part of **Twin-to-Twin Transfusion Syndrome (TTTS)**. The recipient twin develops polyuria due to hypervolemia, leading to polyhydramnios. **High-Yield NEET-PG Pearls:** * **Most common cause:** Idiopathic (approx. 50-60%). * **Most common maternal cause:** Maternal Diabetes Mellitus (osmotic diuresis in the fetus due to hyperglycemia). * **Congenital anomalies:** Associated with neural tube defects (NTDs), GI obstructions (duodenal atresia - "double bubble" sign), and facial clefts. * **Complications:** Preterm labor, Premature Rupture of Membranes (PROM), Cord prolapse, and Postpartum Hemorrhage (PPH) due to uterine atony. * **Management:** Therapeutic amniocentesis (amniodrainage) or Indomethacin (decreases fetal urine output, but contraindicated after 32 weeks due to risk of premature closure of Ductus Arteriosus).

Q: On sonography, a multigravida is found to have oligohydramnios. Which among the following will be associated with this condition?

Renal agenesis. **Explanation:** **Understanding the Concept:** Amniotic fluid volume is a dynamic balance between production and removal. After 12–14 weeks of gestation, **fetal urine** becomes the primary source of amniotic fluid, while **fetal swallowing** is the major route of its removal. **Why Renal Agenesis is Correct:** In cases of **Renal Agenesis** (Potter’s Sequence), the kidneys fail to develop, leading to a total absence of fetal urine production. Since the primary source of fluid is missing, it results in severe **oligohydramnios** (Amniotic Fluid Index < 5 cm or Single Deepest Pocket < 2 cm). **Analysis of Incorrect Options:** * **Oesophageal Atresia:** This condition prevents the fetus from swallowing amniotic fluid. Since the removal mechanism is blocked while urine production continues, it leads to **polyhydramnios**. * **Spina Bifida:** Open neural tube defects (NTDs) cause **polyhydramnios** due to the transudation of cerebrospinal fluid into the amniotic sac and impaired fetal swallowing. * **Chorioangioma of Placenta:** This is a vascular tumor of the placenta. Large chorioangiomas (>5 cm) act as arteriovenous shunts, leading to high-output cardiac failure in the fetus, increased fetal urine production, and subsequent **polyhydramnios**. **NEET-PG High-Yield Pearls:** * **Most common cause of oligohydramnios:** Premature Rupture of Membranes (PROM). * **Most common fetal anomaly associated with oligohydramnios:** Renal anomalies (e.g., Posterior Urethral Valves, Polycystic Kidney Disease). * **Potter’s Sequence:** Oligohydramnios → Pulmonary hypoplasia, flattened facies, and limb deformities (clubfoot). * **Drug-induced oligohydramnios:** ACE inhibitors and NSAIDs (due to decreased fetal renal perfusion).

Question 1

What are the findings in ultrasound suggestive of an incompetent internal os?

Accepted Answer

Cervical length, funneling of amniotic sac, AP length of cervix

Answer

Cervical length, external os, internal os

Answer

Cervical length, funneling of amniotic sac

Answer

External os, internal os

Question 2

Which of the following is NOT implicated in congenital transmission?

Accepted Answer

Hepatitis A

Answer

Toxoplasmosis

Answer

Herpes

Answer

Syphilis

Question 3

Which of the following is NOT a criterion for expectant management in pre-eclampsia?

Accepted Answer

Blood pressure > 140/90 mm Hg

Answer

Platelet count < 100,000/ml

Answer

Urine output < 400 ml/day

Answer

Persistent headache

Question 4

Which of the following is NOT an absolute maternal indication for termination of pregnancy?

Accepted Answer

Parous woman with grade III and IV cardiac lesions

Answer

Eisenmenger's syndrome

Answer

Primary pulmonary hypertension

Answer

Pulmonary veno-occlusive disease

Question 5

Metcalfe's Criteria is used for:

Accepted Answer

Findings suggestive of heart disease in pregnancy

Answer

Assessing risk of maternal mortality in pregnancy

Answer

Grading congenital valvular heart diseases in pregnancy

Answer

Classifying various cardiomyopathies

Question 6

Which of the following does NOT constitute a high-risk pregnancy?

Accepted Answer

A 25-year-old primigravida

Answer

Twins

Answer

Hydramnios

Answer

Previous Lower Segment Caesarean Section (LSCS)

Question 7

A 24-week pregnancy scan revealed frontal facial fetal defects suggestive of Moebius syndrome. Which of the following could account for the teratogenic effects?

Accepted Answer

Misoprostol

Answer

Mifepristone

Answer

Dinoprostone

Answer

Methotrexate

Question 8

What are the causes of hydramnios?

Accepted Answer

All of the above

Answer

Anencephaly

Answer

Oesophageal atresia

Answer

Twins

Question 9

On sonography, a multigravida is found to have oligohydramnios. Which among the following will be associated with this condition?

Accepted Answer

Renal agenesis

Answer

Oesophageal atresia

Answer

Spina bifida

Answer

Cholangioma of placenta

Question 10

What is the most common type of anemia in pregnancy?

Accepted Answer

Microcytic hypochromic anemia

Answer

Megaloblastic anemia

Answer

Microcytic normochromic anemia

Answer

Normochromic normocytic anemia

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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